Thyroid Disorders Show Gender Disparity: Dual Challenges of Rising Prevalence and Low Public Awareness
“Thyroid diseases can lead to various chronic conditions. Moreover, their insidious onset and nonspecific early symptoms contribute to low public awareness, underscoring the significant importance of prevention and control.” At a recent expert symposium on thyroid screening and health education, Wu Jing, Director of the National Center for Chronic and Noncommunicable Disease Control and Prevention at the Chinese Center for Disease Control and Prevention, recommended advancing prevention and control efforts through an integrated approach encompassing prevention, screening, diagnosis, treatment, and rehabilitation. She emphasized leveraging modern technologies, popularizing health knowledge, and strengthening the management of screening and physical examinations to jointly safeguard thyroid health.
Experts call for heightened awareness of screening. Liu Li, a standing committee member of the Disease and Health Management Branch of the Chinese Hospital Association, pointed out that thyroid function screening is a routine and essential component of health checkups, enabling early detection and intervention for thyroid dysfunction. She emphasized that among thyroid function test indicators, TSH (Thyroid-Stimulating Hormone) is the earliest marker for assessment, and recommended that TSH be included as one of the most critical evaluation parameters in health examinations.
Meanwhile, Shan Zhongyan, Chair of the Thyroid Disease Prevention and Control Professional Committee of the Chinese Preventive Medicine Association, emphasized that preventive screening and public education are crucial to improving prevention and control efforts. The significant variations in incidence characteristics and clinical manifestations across different populations have increased the difficulty of prevention and response. Strengthening health science popularization and enhancing public awareness have become urgent priorities. Lin Yansong, Chair of the Thyroid Disease Branch of the China International Exchange and Promotive Association for Medical and Health Care, stated that science popularization is of great significance to clinicians, as it helps focus on patient concerns, improve diagnostic and treatment efficiency, support the development of young physicians, and enhance doctor-patient communication skills.
With the advent of the digital era, artificial intelligence (AI) technology has brought opportunities to healthcare and medicine, offering new tools for thyroid disease education and assisted diagnosis. However, experts also point out that AI has limitations in its application to thyroid health, which should be viewed rationally.
The thyroid gland is hailed as the body’s “vital gland,” playing a pivotal role in maintaining normal physiological functions. However, in recent years, the incidence of thyroid disorders has been on the rise, posing a serious threat to public health.
Thyroid diseases encompass a variety of conditions, including hyperthyroidism, hypothyroidism, thyroid nodules, thyroid cancer, and autoimmune thyroiditis.
Shan Zhongyan pointed out that thyroid diseases exert lifelong impacts on human health. For instance, symptoms caused by hyperthyroidism and hypothyroidism can reduce fertility in women of childbearing age, increase the risks of preterm birth and miscarriage in pregnant women, and potentially affect the intellectual development of their offspring. Thyroid disorders during childhood can impair the growth and development of adolescents. In adulthood, they contribute to abnormal blood glucose and lipid levels, thereby increasing the risk of cardiovascular diseases. Among the elderly, thyroid diseases are more likely to lead to memory decline, dementia, osteoporosis, and an elevated risk of fractures.
Moreover, there is a significant gender disparity in the incidence of thyroid diseases, with a markedly higher prevalence in women than in men, particularly during the reproductive years, exhibiting a female predominance. During physiological stages such as pregnancy, lactation, and menopause, fluctuations in hormone levels can easily affect thyroid function, thereby increasing the risk of disease.
Shan Zhongyan further summarized that the current status of thyroid diseases in China is characterized by “one high and two lows.” The “one high” refers to a high prevalence rate. Epidemiological survey results from 31 provinces and municipalities across China show that the overall prevalence of various thyroid diseases in China is as high as 40%, while the prevalence of thyroid dysfunction is 15.17%. This includes approximately 1% for clinical hypothyroidism, approximately 13% for subclinical hypothyroidism, approximately 1% for clinical hyperthyroidism, and approximately 0.5% for subclinical hyperthyroidism. Additionally, the prevalence of thyroid nodules is as high as 20%.
"The Two Lows" refer to low awareness rates and low treatment rates. An epidemiological survey of thyroid diseases among community residents in a municipality directly under the Central Government revealed that the treatment rate for thyroid diseases in China is only 18%, with an overall treatment rate of less than 5%, significantly lower than those for diabetes, hypertension, and dyslipidemia.
“Public awareness of thyroid diseases is relatively low, yet their prevalence is high, posing significant potential risks. Therefore, it is imperative to strengthen public education and enhance disease awareness,” pointed out Shan Zhongyan.
Meanwhile, at the primary healthcare level, the prevention and control of thyroid diseases face numerous challenges. On one hand, the relative scarcity of equipment, technology, and personnel in primary healthcare institutions limits the accuracy and timeliness of thyroid disease screening and diagnosis. On the other hand, the varying levels of awareness and clinical competence among primary care physicians regarding thyroid disorders make it difficult to meet patients’ healthcare needs. Furthermore, the uneven distribution of medical resources hinders patients in remote areas from accessing high-quality medical services, leading to delays in early diagnosis and treatment.
Notably, among the causes of morphological changes in thyroid function, iodine is one of the most significant influencing factors. “Iodine is the primary raw material for the synthesis of thyroid hormones in the human body and a crucial factor affecting thyroid health. Both iodine deficiency and excess can lead to thyroid diseases. Adhering to iodized salt consumption and scientific iodine supplementation are important pathways to safeguarding thyroid health,” stated Teng Weiping, Honorary Chairman of the Endocrinology Branch of the Chinese Medical Association and Vice President of the Asia-Pacific Thyroid Association. He noted that since China implemented the universal salt iodization program, timely adjustments in iodine intake have led to a general decline in the prevalence of hyperthyroidism, clinical hypothyroidism, and other related conditions.
In the prevention and control strategies for thyroid diseases, screening is a critical component for achieving early detection and intervention. Screening for thyroid diseases enables the timely identification of potential patients, holding particular significance for individuals in high-risk groups or those without obvious symptoms. Through screening, diseases can be nipped in the bud, significantly improving patient prognosis and reducing the harm caused by the disease.
However, Liu Li, a standing committee member of the Disease and Health Management Branch of the Chinese Hospital Association, pointed out that few members of the general public undergo proactive thyroid function screening. This is primarily due to insufficient awareness of thyroid diseases among the general population. Because the symptoms of thyroid diseases are highly insidious and difficult to detect in the early stages, public awareness and attention remain inadequate, leading to the neglect of screening. Furthermore, large-scale population screening raises concerns about overdiagnosis and overtreatment among the public. Consequently, some medical guidelines do not recommend routine screening for individuals without specific risk factors. In addition, the allocation of national medical resources remains uneven.
Liu Li pointed out that thyroid function screening is a mandatory routine item in health checkups, providing opportunities for early detection and intervention in individuals with abnormal thyroid function. The 2022 edition of the Expert Consensus on Basic Items for National Health Checkups has already included thyroid function as a basic checkup item. As an important means of assessing thyroid health, thyroid function screening comprises multiple testing indicators. Among these, Thyroid-Stimulating Hormone (TSH) is the earliest and most sensitive indicator for determining thyroid functional status. Furthermore, for specific thyroid diseases, it may be necessary to test for thyroid autoantibodies, such as Thyroid Peroxidase Antibody (TPOAb) and Thyroglobulin Antibody (TgAb); the detection of these antibodies aids in the diagnosis of autoimmune thyroid diseases.
Screening for thyroid diseases should not be a one-time event but rather an ongoing practice throughout the entire lifespan. As individuals age and their physiological status changes, their risk of developing thyroid disorders also shifts accordingly. For instance, among postmenopausal women, the incidence of thyroid diseases may further increase due to declining estrogen levels and alterations in immune function. Therefore, regular thyroid screening should become an essential component of everyone’s health management plan. Generally, it is recommended that adults undergo thyroid function tests and neck ultrasound examinations every 2 to 5 years; for high-risk populations, screening frequency should be increased based on medical advice.
In clinical practice, screening for thyroid diseases requires a combination of functional and structural assessments to comprehensively evaluate thyroid health. Functional assessment primarily involves blood tests to measure thyroid hormone levels, while structural assessment employs methods such as palpation and ultrasonography to observe the morphology and structure of the thyroid gland. Palpation is a simple and direct examination technique in which the physician manually examines the thyroid region of the neck to preliminarily determine whether abnormalities such as goiter or nodules are present.
However, the accuracy of palpation largely depends on the physician’s experience and skills. Ultrasound examination, by contrast, offers advantages such as being non-invasive, convenient, and high-resolution, enabling clear visualization of the internal structure of the thyroid gland and detection of tiny nodules and lesions. There is no need for excessive panic upon the discovery of thyroid nodules, as the majority are benign adenomatous nodules or cysts. During screening, if thyroid nodules are detected, the need for further examination and management should be determined based on characteristics such as nodule size, morphology, and blood flow, in conjunction with clinical risk assessment.
In today’s era of information explosion, science popularization has become a vital force in enhancing public health literacy and advancing disease prevention and control. For thyroid diseases, scientific, accurate, and accessible educational content can help the public establish correct health concepts and master methods for disease prevention and management.
Lin Yansong pointed out, “Carrying out science popularization work holds multiple significances for clinicians. Through the ‘Stripping Away the False to Preserve the Truth’ initiative, we have found that creating scientific content helps doctors focus on common patient concerns, thereby facilitating clinical diagnosis and treatment and improving efficiency. It also contributes to building a pipeline of young physicians, enhancing doctor-patient communication skills, and optimizing the patient healthcare experience.”
However, current science popularization efforts still face numerous challenges, such as uneven quality of content, limited dissemination channels, and low public engagement.
Furthermore, while science popularization efforts have achieved certain results, they have also exposed several issues. On one hand, some science popularization content lacks scientific rigor and accuracy, with instances of exaggerated efficacy claims that mislead the public. On the other hand, the depth and breadth of science communication need to be expanded. Although the volume of science popularization information continues to increase, there is a relative scarcity of content that is both accessible and easy to understand while remaining targeted and substantive. In addition, there is insufficient coordination in science popularization work, with a lack of effective communication and collaboration mechanisms among various stakeholders. This has led to resource waste and redundant efforts, thereby undermining the overall effectiveness of science popularization initiatives.
In this context, the rise of artificial intelligence (AI) technology has brought new opportunities and transformations to public science education on thyroid diseases.
The application of AI technology in the field of thyroid disease science popularization provides new ideas and methods for addressing the aforementioned issues. For instance, AI can rapidly generate educational content, thereby enhancing the efficiency of science communication efforts. Leveraging natural language processing techniques, AI can automatically produce various forms of educational materials—such as articles, Q&A sessions, and video scripts—based on predefined medical knowledge bases and writing templates. Furthermore, AI possesses robust data analytics and personalized recommendation capabilities, enabling the precise delivery of educational content to target audiences.
In practical applications, the integration of AI with public education on thyroid diseases has already yielded some remarkable achievements. For instance, certain medical institutions and technology companies have collaborated to develop AI-based risk assessment tools for thyroid diseases.
In addition, some pharmaceutical companies are also making strategic moves in the field of AI models, exploring initiatives centered on the dissemination of health science education. Jingmei Mao, Vice President of Merck China Pharmaceuticals and Health and Head of Medical Affairs, believes that digitalization plays a positive role in advancing science communication efforts. She introduced that Merck disseminates thyroid-related educational content through multiple channels, adopting an integrated online-and-offline approach to help enhance public awareness of thyroid diseases. “Merck’s Medical Department established a Digital Medical Advisory Project Team this year. By building a large AI model platform, we aim to explore the application of artificial intelligence in innovative science communication, thereby creating more possibilities for improving national thyroid health and enhancing patient services.”
However, Lin Yansong also pointed out that although AI has become a channel for many people to seek health knowledge, it is recommended that everyone maintain an objective attitude towards the accuracy and scientific nature of the content generated by it to avoid being misled. In addition, AI can only popularize basic knowledge; it does not possess the clinical experience and disease insight of doctors, nor can it engage in doctor-patient communication. It cannot replace clinical diagnosis and treatment, and professional diagnosis by a doctor is still required.
Meanwhile, AI can also generate erroneous information. Lu Wenqing, founder of Mailuo Insight, explained that this is because the knowledge update speed of large AI models is not synchronized with the pace of medical advancements. “The essence of large AI models lies in the probability distribution of pre-existing knowledge. As new medical knowledge and treatment modalities continue to emerge, the data repositories of these large models must be updated in tandem. Multi-party collaboration can be fostered to develop tools such as medical knowledge bases, enabling AI to deliver science popularization content more rapidly and accurately.” He also advised patients to approach AI rationally, emphasizing that treatment plans provided by physicians should ultimately serve as the definitive guide.